Treatment of basal cell carcinomas at high risk for recurrence
- Sumaira Z Aasi, MD
Sumaira Z Aasi, MD
- Clinical Associate Professor, Department of Dermatology
- Stanford University School of Medicine
- Timothy K Chartier, MD
Timothy K Chartier, MD
- Associate Clinical Professor
- Yale University School of Medicine
- Department of Dermatology
- Section Editors
- June K Robinson, MD
June K Robinson, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Clinical Dermatology
- Northwestern University Feinberg School of Medicine
- Robert S Stern, MD
Robert S Stern, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Dermatology
- Harvard Medical School
Basal cell carcinoma (BCC) is a common skin cancer that arises from the basal layer of epidermis and its appendages. Treatment of BCC is indicated due to the locally invasive, aggressive, and destructive effects of BCC on skin and surrounding tissues (picture 1A-B).
Tumor characteristics such as size, location, and pathology influence the likelihood for deep tumor invasion and recurrence of BCC after treatment. Lesions at high risk for recurrence may benefit from removal with Mohs micrographic surgery, a procedure that allows for the assessment of all margins of excised tissue. Alternative therapies include conventional surgical excision and radiation therapy (RT). Electrodessication and curettage (ED&C), cryosurgery, and topical 5-fluorouracil or imiquimod are not recommended for the management of these BCCs (table 1).
The treatment of BCCs with clinical or pathologic features associated with increased risk for recurrence will be reviewed here. The risk factors, clinical manifestations, and prognosis of BCC, as well as the management of less aggressive BCCs, are reviewed separately. The management of advanced BCC is also discussed separately.
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- FEATURES ASSOCIATED WITH HIGH RISK FOR RECURRENCE
- APPROACH TO TREATMENT
- Mohs surgery
- - Efficacy
- - Indications
- - Advantages and disadvantages
- Surgical excision
- Staged excision with circumferential margin assessment
- Radiation therapy
- - Results
- - Short-term effects of radiation therapy
- - Long-term complications
- - Patient selection
- Other therapies
- METASTATIC DISEASE
- PROGNOSIS AND FOLLOW-UP
- SUMMARY AND RECOMMENDATIONS